血清和肽素联合炎症指标在急性脑卒中患者临床诊断与预后评估中的价值  

The value of serum copeptin combined with inflammatory indexes in the clinical diagnosis and prognostic assessment of acute stroke

作　　者：王金全 彭欢子 许莹芊 彭嘉琪 何坤 谭评 胡艳丽 谢小兵[1] Wang Jinquan;Peng Huanzi;Xu Yingqian;Peng Jiaqi;He Kun;Tan Ping;Hu Yanli;Xie Xiaobing(Department of Medical Laboratory Center,the First Affiliated Hospital of Hunan University of Chinese Medicine,Changsha 410007,China)

机构地区：[1]湖南中医药大学第一附属医院医学检验中心,长沙410007

出　　处：《中华检验医学杂志》2025年第3期378-389,共12页Chinese Journal of Laboratory Medicine

基　　金：广东省钟南山医学基金会(ZNSXS-20240045);湖南中医药大学学科建设“揭榜挂帅”项目(22JBZ037);湖南中医药大学教改课题重点项目(2020-JG002);病毒学国家重点实验室开放研究基金(2024KF001)。

摘　　要：目的建立血清和肽素与炎症指标联合检测急性脑卒中(AS)的模型,探讨和肽素与炎症指标检测在AS临床诊断与预后评估中的价值。方法病例对照研究。纳入2024年1月1日至7月31日于湖南中医药大学第一附属医院经急诊入院诊断为急性缺血性卒中(AIS)患者75例[男性46例,年龄(64.1±11.7)岁]和急性脑出血(ICH)患者45例[男性28例,年龄(61.0±13.9)岁]作为观察组,同期健康人60名[男性39名,年龄(64.4±8.2)岁]作为对照组(HC),比较不同组别之间血清和肽素水平和炎症指标的差异;绘制ROC曲线并分析和肽素与炎症指标对AS临床诊断和预后评估的价值;采用Kaplan-Meier法绘制生存曲线分析不同组别患者的住院期间生存率;Cox回归分析影响AS患者预后的危险因素。结果和肽素水平在AS表现为明显地升高,结果显示ICH>AIS>HC(H=100.11,P<0.001);和肽素对AIS和ICH早期诊断(分别为AUC=0.893、敏感度89.3%、特异度75.0%;AUC=0.986、敏感度95.6%、特异度93.3%)与评估预后(分别为AUC=0.997、敏感度100%、特异度96.8%;AUC=0.907、敏感度86.7%、特异度86.7%)的效能最高,优于其他单一指标;和肽素与中性粒细胞与淋巴细胞比值(NLR)和全身免疫炎症反应指数(SIIRI)联合检测分别是AIS和ICH早期诊断(分别为AUC=0.937、敏感度77.3%、特异度98.3%;AUC=0.989、敏感度95.6%、特异度95.0%)与评估预后(分别为AUC=0.996、敏感度100%、特异度96.8%;AUC=0.944、敏感度86.7%、特异度90.0%)的最佳组合;Kaplan-Meier生存曲线显示和肽素、NLR低值组的AIS患者住院期间生存率较高值组良好(HR分别是54.46、7.608,P<0.01),和肽素、SIIRI、全身免疫反应指数(SIRI)、全身免疫炎症指数(SII)低值组的ICH患者住院期间生存率较高值组良好(HR分别是12.67、7.923、3.567、5.925,P<0.05);Cox回归显示和肽素、NLR、术前美国国立卫生研究院脑卒中量表(NIHSS)以及改良Rankin量表(mRS)是影响AIS患者预后的独立危险Objective To establish a model for the combined detection of serum copeptin and inflammatory markers in acute stroke(AS),and to explore the value of copeptin and inflammatory marker detection in the clinical diagnosis and prognosis assessment of AS.Methods A total of 75 patients were diagnosed with acute ischemic stroke(AIS)[46 males,age(64.1±11.7)years]and 45 patients with acute intracerebral hemorrhage(ICH)[28 males,age(61.0±13.9)years]who were admitted to the First Affiliated Hospital of Hunan University of Chinese Medicine through the emergency department from January 1 to July 31,2024,were included as the observation group.Meanwhile,60 healthy individuals[39 males,age(64.4±8.2)years]were selected as the control group(HC).The differences in serum copeptin levels and inflammatory markers among different groups were compared.ROC curves were drawn to analyze the value of copeptin and inflammatory markers in the clinical diagnosis and prognosis assessment of AIS.The Kaplan-Meier method was used to draw survival curves to analyze the in-hospital survival rates of patients in different groups.Cox regression analysis was conducted to identify the risk factors affecting the prognosis of AIS patients.Results The level of copeptin was significantly elevated in AS,with the results showing ICH>AIS>HC(H=100.11,P<0.001).Copeptin demonstrated the highest efficacy in the early diagnosis of AIS and ICH(AUC=0.893,sensitivity 89.3%,specificity 75.0%;AUC=0.986,sensitivity 95.6%,specificity 93.3%)and the assessment of prognosis(AUC=0.997,sensitivity 100%,specificity 96.8%;AUC=0.907,sensitivity 86.7%,specificity 86.7%),outperforming other single indicators.The combined detection of copeptin with the neutrophil-to-lymphocyte ratio(NLR)and the systemic immune-inflammation index(SIIRI)was the best combination for the early diagnosis of AIS and ICH(AUC=0.937,sensitivity 77.3%,specificity 98.3%;AUC=0.989,sensitivity 95.6%,specificity 95.0%)and for the assessment of prognosis(AUC=0.996,sensitivity 100%,specificity 96.8%;AUC=0.944,sen

关 键 词：脑卒中 诊断 预后 和肽素 炎症指标 

分 类 号：R743.3[医药卫生—神经病学与精神病学]